Zika virus gives Baylor tropical disease expert a global...

1of11Dr. Peter Hotez, dean of the school of Tropical Medicine at Baylor College of Medicine, leads a tour of the Fifth Ward, Monday, Oct. 3, 2016, in Houston. Dr. Hotez, a global leader in infectious disease research, is studying how undiagnosed infectious diseases can effect vulnerable populations. He sees all of the vectors needed for the spread of diseases thought to be rare in the United States are present in disadvantaged areas of Houston. ( Mark Mulligan / Houston Chronicle )Photo: Mark Mulligan, Staff

2of11Dr. Peter Hotez, dean of the school of Tropical Medicine at Baylor College of Medicine, leads a tour of the Fifth Ward, Monday, Oct. 3, 2016, in Houston. Dr. Hotez, a global leader in infectious disease research, is studying how undiagnosed infectious diseases can effect vulnerable populations. He sees all of the vectors needed for the spread of diseases thought to be rare in the United States are present in disadvantaged areas of Houston. ( Mark Mulligan / Houston Chronicle )Photo: Mark Mulligan, Staff

3of11Dr. Peter Hotez, dean of the school of Tropical Medicine at Baylor College of Medicine, leads a tour of the Fifth Ward, Monday, Oct. 3, 2016, in Houston. Dr. Hotez, a global leader in infectious disease research, is studying how undiagnosed infectious diseases can effect vulnerable populations. He sees all of the vectors needed for the spread of diseases thought to be rare in the United States are present in disadvantaged areas of Houston. ( Mark Mulligan / Houston Chronicle )Photo: Mark Mulligan, Staff

4of11Dr. Peter Hotez, dean of the school of Tropical Medicine at Baylor College of Medicine, leads a tour of the Fifth Ward, Monday, Oct. 3, 2016, in Houston. Dr. Hotez, a global leader in infectious disease research, is studying how undiagnosed infectious diseases can effect vulnerable populations. He sees all of the vectors needed for the spread of diseases thought to be rare in the United States are present in disadvantaged areas of Houston. ( Mark Mulligan / Houston Chronicle )Photo: Mark Mulligan, Staff

5of11Dr. Peter Hotez, dean of the school of Tropical Medicine at Baylor College of Medicine, leads a tour of the Fifth Ward, Monday, Oct. 3, 2016, in Houston. Dr. Hotez, a global leader in infectious disease research, is studying how undiagnosed infectious diseases can effect vulnerable populations. He sees all of the vectors needed for the spread of diseases thought to be rare in the United States are present in disadvantaged areas of Houston. ( Mark Mulligan / Houston Chronicle )Photo: Mark Mulligan, Staff

6of11Discarded garbage and other junk provides a perfect habitat for mosquitos, says Dr. Peter Hotez, dean of the school of Tropical Medicine at Baylor College of Medicine, during a tour of the Fifth Ward, Monday, Oct. 3, 2016, in Houston. Dr. Hotez, a global leader in infectious disease research, is studying how undiagnosed infectious diseases can effect vulnerable populations. He sees all of the vectors needed for the spread of diseases thought to be rare in the United States are present in disadvantaged areas of Houston. ( Mark Mulligan / Houston Chronicle )Photo: Mark Mulligan, Staff

7of11In this photo taken June 1, 2016, Dr. Peter Hotez, Dean of the Baylor College of Tropical Medicine, shows an Associated Press reporter and video journalist areas of Houston's 5th Ward that may be at high risk for mosquitoes capable of transmitting the Zika virus in Houston. The Aedes aegypti species is typically found anywhere standing water can accumulate. (AP Photo/John Mone)Photo: John Mone, STF

8of11Discarded garbage and other junk provides a perfect habitat for mosquitos, says Dr. Peter Hotez, dean of the school of Tropical Medicine at Baylor College of Medicine, during a tour of the Fifth Ward, Monday, Oct. 3, 2016, in Houston. Dr. Hotez, a global leader in infectious disease research, is studying how undiagnosed infectious diseases can effect vulnerable populations. He sees all of the vectors needed for the spread of diseases thought to be rare in the United States are present in disadvantaged areas of Houston. ( Mark Mulligan / Houston Chronicle )Photo: Mark Mulligan, Staff

9of11During a meeting of the Texas Senate Committee on Health and Human Services, Dr. Peter Hotez, Dean of the Baylor College of Medicine National School of Tropical Medicine, discusses the current and future effects of the Zika Virus in Texas during a hearing May 17 to evaluate the state's ability to effectively respond to challenges posed by the virus and explore what actions should be taken to prevent transmission, including mosquito control efforts. (Photos by Tom McCarthy Jr.)Photo: Tom McCarthy Jr.

10of11Dr. Peter Hotez, dean of the school of Tropical Medicine at Baylor College of Medicine, leads a tour of the Fifth Ward, Monday, Oct. 3, 2016, in Houston. Dr. Hotez, a global leader in infectious disease research, is studying how undiagnosed infectious diseases can effect vulnerable populations. He sees all of the vectors needed for the spread of diseases thought to be rare in the United States are present in disadvantaged areas of Houston. ( Mark Mulligan / Houston Chronicle )Photo: Mark Mulligan, Staff

11of11Dr. Peter Hotez, president of the Sabin Vaccine Institute and founding dean of the School of Tropical Medicine at Baylor College of Medicine, poses for a portrait in the institute's lab Wednesday, April 11, 2012, in Houston. Dr. Hotez is a U.S. science envoy. (AP Photo/Houston Chronicle, Brett Coomer)Photo: Brett Coomer, MBI

Dr. Peter Hotez has a whiteboard in his office at Baylor College of Medicine to remind him of upcoming appointments. One afternoon last fall, it listed interviews with The New York Times and Huffington Post, a telephone call with an Obama administration official, and a trip to Berlin to speak at the World Health Summit.

"I stay busy," Hotez said.

The renowned expert in infectious tropical diseases hasn't always been in such high demand.

In 2015, he became one of the first scientists to warn that a mosquito-borne epidemic devastating parts of Central America would eventually spread north to the United States. Type "Hotez" into Google, and the search engine automatically fills in "Zika."

But that emerging viral threat is symbolic of a far bigger problem, Hotez said, one that he's been warning about for years: Growing income inequality is driving the spread of a whole class of undiagnosed diseases that are likely leading to developmental disorders in children - with Texas, and Houston specifically - at the epicenter. The diseases Hotez warns about have names most of their victims struggle to pronounce: Cysticercosis, Murine typhus, Leishmaniasis, among others.

Like Zika, most cause few obvious symptoms and primarily afflict people who don't regularly see a doctor. So they spread silently, though their effects can be devastating. For example, Hotez estimates Toxocariasis - a parasitic worm infection of the brain spread by stray cats and dogs - affects one out of every three black children living in poverty in America, in some cases causing developmental delays.

"Is it possible toxocariasis is a major cause of the achievement gap?" Hotez said. "The evidence suggests it could be."

But there's no celebrity leading the charge to eradicate such diseases.

Not unless you count Hotez, who a decade ago coined the term "neglected tropical diseases" to express his frustration with the global community's indifference on the subject. Some in his field - taking note of his signature neckwear and his commitment to diseases besetting the poor - have dubbed the 58-year-old scientist, "Bono with a bow tie."

In Berlin last year, Hotez told an international audience that millions of Americans are living with a neglected tropical disease, and he pointed to the growing gap between rich and poor as the leading cause.

Back in Texas, he doesn't even try to hide his dissatisfaction with the lack of progress.

"We've been speaking about this problem now for many years," he said. "But nobody's been listening."

Finally, it seems, the Zika virus, and fears about its potential devastation in the United States, has handed him an audience.

Treating unusual infections at Houston clinic

Five years ago, when Hotez came to Houston to create the National School of Tropical Medicine at Baylor, he imagined his work would focus on studying and developing vaccines for diseases plaguing the poorest swaths of Latin America.

Then he started driving around his new city. He pulled off the highway and turned down roads many of his colleagues at the Texas Medical Center try to avoid.

"I thought I knew what poverty looked like being in Washington, D.C., but this is a different animal," Hotez said recently while traveling with a reporter through Houston's Fifth Ward, on the city's northeast side. "Keep in mind, this is only a few miles away from one of the world's most advanced medical centers."

He pointed to a line of dilapidated row houses. To broken glass and torn window screens. To piles of discarded televisions and car tires collecting rainwater. To stray dogs wandering through yards.

It was here, while exploring with his wife five years ago, that Hotez began to rethink the direction of his work. Houston had everything needed for the spread of the diseases he'd spent decades studying in Africa and southeast Asia: A hot climate, a growing number of blood-sucking insects, a large international population - and, most importantly, extreme poverty.

"We're in a disease-endemic country," Hotez said, pointing out the car window. "The Republic of Texas."

That reality is on display one day each week when a wing of the Smith Clinic in Houston is transformed into a clinic of tropical medicine, where physicians working under Hotez treat patients with all manner of unusual diseases, from dengue fever to river blindness. Many became ill after traveling abroad, but plenty have never left Texas, said Dr. Rojelio Mejia, an assistant professor of infectious diseases and pediatrics at Baylor.

One Friday last year, Mejia prepared to treat patients suffering from a tapeworm that causes seizures, a flatworm carried by snails that can lead to liver damage or kidney failure, and Chagas disease, a potentially fatal illness carried by the so-called "kissing bug," which is common in Texas.

"These are diseases that are transmitted locally," said Mejia, who recently uncovered a resurgence of hookworm in rural Alabama and hopes to replicate the study in Texas. "People don't really have an understanding of what's out there."

Neither do most doctors, Hotez said: "That's why a big part of our mission here is to educate physicians."

If a patient comes in with epilepsy, the doctor doesn't think cysticercosis, a tissue infection caused by a tapeworm found in pork. If one comes in with heart failure, they don't think Chagas disease. So the disease lingers. The symptoms worsen. Adults become too ill to go to work. Children struggle in school. And soon, Hotez said, "illnesses caused by poverty also trap people there."

"This is what we're up against," he said. "This is why we need to conduct active surveillance. That means going into communities and testing kids. It means developing new vaccines and treatments."

Researchers working under Hotez are making progress, but funding remains a challenge. A Baylor team recently developed an improved method to better detect toxocariasis, the pervasive parasitic worm that he worries is causing neurological disorders in an untold number of children. They wrote a grant to the National Institutes of Health to conduct additional research on the concept.

"But of course it didn't get funded," Hotez said, shaking his head. "It's not one of the imaginary illnesses that scare white people. … It's not Ebola."

Tamping down Ebola fears

Don't get him started on Ebola.

A few years ago, when a Dallas nurse became ill with the virus after treating a patient who'd traveled to Africa, Hotez saw an opportunity in the media hysteria.

He rode a New York subway train with an MSNBC anchor to explain why you probably wouldn't catch Ebola there. On CNBC, he declared the risk of an epidemic in America "is near zero." And on Newsmax TV - after a host teased him for wearing a "whimsy" bowtie "in stark contrast to the serious topic of Ebola" - Hotez tried to shift the conversation.

"We already have an estimated 12 million Americans living with one or more neglected tropical diseases," Hotez said, surprising the anchors as the network flashed images of aid workers carrying dead bodies in Ebola-stricken Liberia. "The likelihood of Ebola coming to the U.S. is extremely remote, and we need to start paying some attention to diseases that are already here."

The host cut him off. Hotez got used to hearing anchors say, "Well, thank you doctor, but we're out of time."

Zika has been different. The virus, which causes the birth defect microcephaly, swept through South America before making its way to Miami last summer. This time, Hotez thinks the threat is real, and journalists are eager to listen.

"If you start seeing babies with microcephaly on the Gulf Coast of the United States," Hotez told CBS News last year, "it is going to be a public health crisis. It will be the public health equivalent of Katrina."

He's taken every opportunity to pitch stories to reporters on the role poverty plays.

Two days after his trip to Berlin last fall, and a day before flying to New York to meet with other world leaders, Hotez walked into Brazos Bookstore on Bissonnet Street and greeted a crowd of about 30 people who'd come to hear him read from his latest book.

"Let's open the wine," Hotez said, acknowledging it had been a harried few days.

Hotez told the crowd he struggles to "stay a working scientist" while spending so much of his time raising awareness of tropical diseases and working to shape public health policy.

The book, "Blue Marble Health," is part of that work. In it, Hotez writes about the spread of neglected diseases among the poor in developed countries and lays out a strategy for combating the problem.

"What we've found," Hotez said to begin the talk, "is that it's the poor living among the wealthy that now account for most of the world's neglected and emerging infections. ... That includes right here in Houston."

His wife, Ann, sat in the audience, snapping photos as he read.

"He's been talking about this for years, his whole life, really," she said afterward, recalling that he'd been teased as a child because of his early interest in tropical diseases. "I'm glad he's getting attention for it now."

Last year, Hotez and others successfully lobbied Texas lawmakers to establish a state program to screen for neglected diseases, often affecting a disproportionate number of poor people. But the bill came with no money. And in Washington, the "End Neglected Tropical Diseases Act" has failed to progress in the last two Congressional sessions.

With Zika, Congress finally approved $1.1 billion to fight the virus in late September - just as the season for mosquito-borne illnesses was ending. Without money to screen large numbers of patients, Hotez has little doubt Zika has been spreading undetected in Texas, including in the Houston metro area.

"Congress dragged its feet and dragged its feet," he said. "What affects people who live in poverty on the Gulf Coast or in Florida or Texas - that doesn't matter."

Mike Hixenbaugh is an investigative reporter focused on exposing fraud and abuse in health care. Previously, he was a reporter at The Virginian-Pilot in Norfolk, Va., where his work on the military and veterans affairs was co-published with ProPublica, NBC News and the Investigative Reporting Program at UC Berkeley. Mike graduated from the University of Akron in 2007, before going to work for small newspapers in Ohio and then North Carolina.